Provider Demographics
NPI:1407253297
Name:CLIFTON, CORY M (IDC)
Entity Type:Individual
Prefix:MR
First Name:CORY
Middle Name:M
Last Name:CLIFTON
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ARROWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-2507
Mailing Address - Country:US
Mailing Address - Phone:910-546-1095
Mailing Address - Fax:
Practice Address - Street 1:22 ARROWOOD DR
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-2507
Practice Address - Country:US
Practice Address - Phone:910-546-1095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman